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Effectiveness of Pharmacy Policies Designed to Limit Inappropriate Vancomycin Use: A Population-Based Assessment

Published online by Cambridge University Press:  02 January 2015

Ann R. Thomas ,
Paul R. Cieslak ,
Larry J. Strausbaugh  and
David W. Fleming
Ann R. Thomas*
Affiliation:
Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Paul R. Cieslak
Affiliation:
Department of Human Services, Office of Disease Prevention and Epidemiology, Portland, Oregon
Larry J. Strausbaugh
Affiliation:
Veterans Affairs Medical Center and the Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, Oregon
David W. Fleming
Affiliation:
Department of Human Services, Office of Disease Prevention and Epidemiology, Portland, Oregon
*
Department of Human Services, Office of Disease Prevention and Epidemiology, 800 NE Oregon Street, Suite 772, Portland, OR 97232
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Abstract

Objective:

In Oregon in 1994, a population-based study of 66 nonpsychiatric hospitals indicated that 40% of vancomycin orders were inappropriate according to Centers for Disease Control and Prevention guidelines. We repeated the study to determine whether vancomycin use had been affected by pharmacy policies implemented following the 1994 study.

Methods:

We surveyed pharmacists in nonpsychiatric hospitals in Oregon regarding vancomycin use policies in their hospitals. Using pharmacy records, we identified and abstracted the charts of all patients in Oregon hospitals receiving vancomycin during a 3-week period to determine appropriate use of vancomycin.

Results:

Thirteen (20%) of 64 hospitals had implemented a vancomycin restriction policy since 1994; none of the remaining hospitals in the study had a policy. In 1999, hospitals with vancomycin restriction policies had substantially decreased rates of inappropriate vancomycin use compared with hospitals without such policies (1.0 vs 1.8 orders per 1,000 patient-days; P = .01). Compared with 1994 baseline rates of inappropriate use, hospitals that adopted policies experienced a decrease (from 1.5 orders per 1,000 patient-days in 1994 to 1.0 in 1999; P= .13), whereas hospitals without policies experienced a statistically significant increase (from 0.9 orders per 1,000 patient-days in 1994 to 1.8 in 1999; P = .001). Restriction policies were most effective at reducing rates of inappropriate use for treatment of confirmed gram-positive infections and prophylaxis.

Conclusion:

Vancomycin restriction policies were associated with a decrease in inappropriate therapeutic and prophylactic vancomycin use, but had no effect on inappropriate empiric use. Hospitals considering limits regarding inappropriate use should consider implementation of institution-based vancomycin restriction policies as part of an overall strategy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 11 , November 2002 , pp. 683 - 688
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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